Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page R1
SUBSTANCE USE DISORDERS
in the U.S. Armed Forces
Committee on Prevention, Diagnosis, Treatment and Management of
Substance Use Disorders in the U.S. Armed Forces
Board on the Health of Select Populations
Charles P. O’Brien, Maryjo Oster, and Emily Morden, Editors
OCR for page R2
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Govern-
ing Board of the National Research Council, whose members are drawn from the
councils of the National Academy of Sciences, the National Academy of Engineer-
ing, and the Institute of Medicine. The members of the committee responsible for
the report were chosen for their special competences and with regard for appropri-
ate balance.
This study was supported by the U.S. Department of Defense through an inter-
agency agreement with the U.S. Department of Health and Human Services under
Contract No. HHSP23337030T. Any opinions, findings, conclusions, or recom-
mendations expressed in this publication are those of the author(s) and do not
necessarily reflect the view of the organizations or agencies that provided support
for this project.
International Standard Book Number-13: 978-0-309-26055-8
International Standard Book Number-10: 0-309-26055-8
Additional copies of this report are available from the National Academies Press,
500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202)
334-3313; http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page
at: www.iom.edu.
Copyright 2013 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost
all cultures and religions since the beginning of recorded history. The serpent
adopted as a logotype by the Institute of Medicine is a relief carving from ancient
Greece, now held by the Staatliche Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2013. Substance use disorders in
the U.S. armed forces. Washington, DC: The National Academies Press.
OCR for page R3
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
Advising the Nation. Improving Health.
OCR for page R4
The National Academy of Sciences is a private, nonprofit, self-perpetuating society
of distinguished scholars engaged in scientific and engineering research, dedicated to
the furtherance of science and technology and to their use for the general welfare.
Upon the authority of the charter granted to it by the Congress in 1863, the Acad-
emy has a mandate that requires it to advise the federal government on scientific
and technical matters. Dr. Ralph J. Cicerone is president of the National Academy
of Sciences.
The National Academy of Engineering was established in 1964, under the charter
of the National Academy of Sciences, as a parallel organization of outstanding
engineers. It is autonomous in its administration and in the selection of its members,
sharing with the National Academy of Sciences the responsibility for advising the
federal government. The National Academy of Engineering also sponsors engineer-
ing programs aimed at meeting national needs, encourages education and research,
and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi-
dent of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions in
the examination of policy matters pertaining to the health of the public. The Insti-
tute acts under the responsibility given to the National Academy of Sciences by its
congressional charter to be an adviser to the federal government and, upon its own
initiative, to identify issues of medical care, research, and education. Dr. Harvey V.
Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sci-
ences in 1916 to associate the broad community of science and technology with the
Academy’s purposes of furthering knowledge and advising the federal government.
Functioning in accordance with general policies determined by the Academy, the
Council has become the principal operating agency of both the National Academy
of Sciences and the National Academy of Engineering in providing services to the
government, the public, and the scientific and engineering communities. The Coun-
cil is administered jointly by both Academies and the Institute of Medicine. Dr.
Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of
the National Research Council.
www.national-academies.org
OCR for page R5
COMMITTEE ON PREVENTION, DIAGNOSIS,
TREATMENT AND MANAGEMENT OF SUBSTANCE
USE DISORDERS IN THE U.S. ARMED FORCES
CHARLES P. O’BRIEN (Chair), Kenneth E. Appel Professor of
Psychiatry and Vice-Chair of Psychiatry, and Director, Center for
Studies of Addiction, University of Pennsylvania School of Medicine,
Philadelphia
HORTENSIA D. AMARO, Associate Vice Provost for Community
Research Initiatives and Dean’s Professor of Social Work and
Preventive Medicine, University of Southern California, Los Angeles
RHONDA ROBINSON BEALE, Chief Medical Officer, OptumHealth
Behavioral Solutions, Glendale, CA
ROBERT M. BRAY, Senior Research Psychologist and Senior Director of
the Substance Abuse Epidemiology and Military Behavioral Health
Program, RTI International, Research Triangle Park, NC
RAUL CAETANO, Regional Dean and Professor, Dallas Regional
Campus of the University of Texas School of Public Health
MATHEA FALCO, President, Drug Strategies, Inc., Washington, DC
JOYCE M. JOHNSON, Vice President of Health Services, Battelle
Memorial Institute, Arlington, VA
THOMAS KOSTEN, J.H. Waggoner Chair and Professor of Psychiatry,
Pharmacology and Neuroscience, Baylor College of Medicine,
Houston, TX
MARY JO LARSON, Senior Scientist, Schneider Institutes for Health
Policy, Heller School, Brandeis University, Waltham, MA
DAVID C. LEWIS, Professor Emeritus of Community Health and
Medicine, and the Donald G. Millar Distinguished Professor of
Alcohol and Addiction Studies, Brown University, Providence, RI
DENNIS McCARTY, Professor of Public Health and Preventive Medicine
and Division Head, Health Services Research, Oregon Health and
Science University, Portland
MARY ANN PENTZ, Professor of Preventive Medicine and Director,
Institute for Health Promotion and Disease Prevention Research,
University of Southern California, Los Angeles
TRACY STECKER, Assistant Professor of Community and Family
Medicine, Dartmouth Medical School, Lebanon, NH
CONSTANCE WEISNER, Professor of Psychiatry, University of
California, and Associate Director for Health Services Research,
Kaiser Permanente, Oakland
v
OCR for page R6
IOM Staff
MARYJO M. OSTER, Study Director
EMILY C. MORDEN, Research Associate
JON Q. SANDERS, Program Associate
NANCY LESTER, Uniformed Services University of the Health Sciences
Intern (Spring 2012)
ANDREA COHEN, Financial Associate
FREDERICK (RICK) ERDTMANN, Director, Board on the Health of
Select Populations
vi
OCR for page R7
Reviewers
T
his report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with
procedures approved by the National Research Council’s Report
Review Committee. The purpose of this independent review is to provide
candid and critical comments that will assist the institution in making its
published report as sound as possible and to ensure that the report meets
institutional standards for objectivity, evidence, and responsiveness to the
study charge. The review comments and draft manuscript remain confiden-
tial to protect the integrity of the deliberative process. We wish to thank the
following individuals for their review of this report:
Thomas F. Babor, University of Connecticut Health Center
Mady Chalk, Treatment Research Institute
Arthur T. Dean, Community Anti-Drug Coalitions of America
Michael Fitzsimons, Massachusetts General Hospital
Deirdre Hiatt, Managed Health Network
Cristine S. Hunter, U.S. Office of Personnel Management
Kimberly C. Kirby, Treatment Research Institute
Daniel Kivlahan, VA Puget Sound Health Care System
James McKay, Treatment Research Institute
Thomas McLellan, Treatment Research Institute
Roland S. Moore, Pacific Institute for Research and Evaluation
Rumi Kato Price, Washington University School of Medicine
Eve E. Reider, National Institute on Drug Abuse
Stephen N. Xenakis, U.S. Army (Ret.)
vii
OCR for page R8
viii REVIEWERS
Although the reviewers listed above have provided many constructive
comments and suggestions, they were not asked to endorse the conclusions
or recommendations nor did they see the final draft of the report before its
release. The review of this report was overseen by Richard J. Bonnie, Uni-
versity of Virginia, and Susan J. Curry, The University of Iowa. Appointed
by the National Research Council and the Institute of Medicine, they were
responsible for making certain that an independent examination of this
report was carried out in accordance with institutional procedures and that
all review comments were carefully considered. Responsibility for the final
content of this report rests entirely with the authoring committee and the
institution.
OCR for page R9
Preface
S
ubstance abuse has long been an issue of concern for the U.S. popula-
tion and for its military in particular. Dating as far back as the Revo-
lutionary War, Dr. Benjamin Rush detailed the effects of alcohol on
the troops. During the Civil War, addiction to opium prescribed for pain
became known as the “soldier’s disease.” Drug problems in both the mili-
tary and civilian sectors have intensified throughout the 20th century as the
types and formulations of substances being used have increased.
Since the 1970s, the Institute of Medicine (IOM) has been called upon
numerous times to advise the government on both medical and legal solu-
tions to the problem of substance abuse. Experts from various fields, rang-
ing from mathematics and epidemiology to pharmacology and law, have
spent many hours on about a dozen different committees struggling with
this thorny problem, which affects our country on societal, economic,
personal, and public health levels. While the popular substances of abuse
may shift from decade to decade, the overarching problem continues. In the
21st century, prescription opioid abuse has arisen as a major area of con-
cern while problems of alcohol, nicotine, and stimulants have persisted as
well. Research has demonstrated that stress and availability are important
background factors for causing the initiation and abuse of drugs. As the
United States approaches the end of the longest continuous period of war
in our history, the stresses faced by our military population are apparent.
Our all-volunteer military has endured long periods of deployment and
redeployment in highly taxing and demanding environments. Consequently,
posttraumatic stress, traumatic brain injury, substance abuse, and suicide
are at very high levels.
ix
OCR for page R10
x PREFACE
Press reports of substance abuse among the military stimulated congres-
sional interest and a call for action. The Department of Defense requested
that the IOM take a fresh look at the policies and programs of each of the
branches of the military and evaluate the adequacy and appropriateness
of their prevention, screening, diagnosis, and treatment of substance use
disorders. The committee approached this task by holding public meetings
to gather information from representatives of each of the military branches
and TRICARE (the military’s purchased care health plan), as well as from
academic researchers and interested members of the public. The committee
also conducted visits to military bases and met with a variety of care pro-
viders, including those working in substance abuse specialty programs and
those in primary care, behavioral health, and pain management.
The committee requested information from each branch of the military
and from TRICARE Management Activity regarding program descriptions,
access, utilization, and evaluation results. We also requested data on the
providers in the substance abuse programs. We extend our appreciation for
the exceptional cooperation from all of those who presented at our meet-
ings, hosted our visits to military bases, and assisted with our information
gathering efforts.
In addition, the committee wishes to express our appreciation to the
study director, Dr. Maryjo Oster, and to the IOM staff, Ms. Emily Morden,
Mr. Jon Sanders, and Dr. Rick Erdtmann.
Charles P. O’Brien, Chair
Committee on Prevention, Diagnosis, Treatment and Management
of Substance Use Disorders in the U.S. Armed Forces
OCR for page R11
Acknowledgments
T
he committee thanks the Department of Defense, the individual ser-
vice branches, and TRICARE Management Activity for the oppor-
tunity to review and comment upon the organization and content
of their substance used disorders prevention and treatment services. We
appreciate their assistance and collaboration in the review.
Many individuals assisted the committee in its work by providing
useful data and presenting information at the committee’s public meetings
and during its site visits. We thank the following people for their contri-
butions: Capt. Robert DeMartino, Alfred Ozanian, Greg Woskow, Frank
Lee, and Diana D. Jeffery, TRICARE Management Activity; Les McFarling,
Army Center for Substance Abuse Programs; Charles Gould, U.S. Navy
Bureau of Medicine and Surgery; Lt. Col. Mark S. Oordt, U.S. Air Force
Medical Operations Agency; Keith Humphreys, Stanford University; Don
Jansen, Congressional Research Service; Brig. Gen. Margaret Wilmoth,
Office of the Assistant Secretary of Defense for Health Affairs; Col. John
J. Stasinos, Department of the Army, Office of the Surgeon General; Capt.
Mary Rusher, Naval Medical Center San Diego; Vladimir Nacev, Defense
Centers of Excellence; Col. Charles Milliken, Walter Reed Army Insti-
tute of Research; Wilson Compton and Eve Reider, National Institute
on Drug Abuse; John Veneziano, Marine Corps Consolidated Substance
Abuse Counseling Center; Ted Jutson and Jerry Sinel, Navy Drug and
Alcohol Counselor School; John Sparks, TRICARE Regional Office-West;
Andrea Brooks Tucker, TRICARE Regional Office-South; Marie Mentor,
TRICARE Regional Office-North; Frank Maguire, TriWest; Debbie Del
Rosario and Gary Proctor, ValueOptions; Ian Schaffer and John Wagoner,
xi
OCR for page R16
OCR for page R17
Tables, Figures, and Boxes
TABLES
1-1 Military Policies Addressing Substance Use Disorders as of
February 2009, 18
1-2 Military Policies Addressing Substance Use Disorders as of May
2012, 19
2-1 Size of the Military Active Duty and Reserve Components in Fiscal
Year 2010, 33
2-2 Sociodemographic Characteristics of Active Duty and Reserve
Component Personnel in Fiscal Year 2010, 35
2-3 Sociodemographic Correlates of Past 30-Day Heavy Alcohol Use,
Cigarette Use, and Illicit Drug Use, Including Prescription Drug
Misuse, 2008, 44
2-4 Alcohol AUDIT Scores of Active Duty and Reserve Component
Personnel, 49
2-5 Health Care Burden Attributable to Substance Use Disorder and
Three Other Mental Disorders, and Rank Among 139 Diseases and
Conditions, Active Duty Component of U.S. Military, 2011, 57
3-1 Reserve Component Health Care Continuum, 75
3-2 Continuum of Care When on Active Duty, 76
3-3 Military Treatment Facilities That Provide Specialty Care for
Substance Abuse, by TRICARE Region, 78
3-4 TRICARE Regions and Contractors, 79
xvii
OCR for page R18
xviii TABLES, FIGURES, AND BOXES
5-1 Best-Practice Domains and Recommendations of the National
Institutes of Health’s Behavior Change Consortium, 115
5-2 A Delivery System Approach Based on the Center for Substance
Abuse Treatment’s (CSAT’s) Treatment Improvement Protocol
No. 47, 117
6-1 Military Programs Mentioning Dependents, 166
7-1 Utilization of Alcohol and Drug Abuse Prevention and Treatment
(ADAPT) Services by Active Duty Air Force Personnel, 193
7-2 Army Active Duty Initial Referrals to the Army Substance Abuse
Program (ASAP), 195
7-3 Utilization of Substance Abuse and Rehabilitation Program
(SARP) Treatment by Active Duty Navy and Marine Corps
Members, 198
7-4 Numbers of Active Duty Marines Receiving Substance Abuse
Counseling Center (SACC) Screening and Completing
Treatment, 199
7-5 Numbers of Dependent Beneficiaries Receiving SUD Care in
Military Treatment Facilities by TRICARE Region (FY 2010), 200
7-6 Number of Active Duty Service Members (ADSMs) and Active
Duty Family Members (ADFMs) Who Accessed Care at Military
Treatment Facilities for an SUD Diagnosis by Type of Service
(FY 2010), 200
7-7 Substance Use Disorders of Operation Iraqi Freedom (OIF)/
Operation Enduring Freedom (OEF)/Operation New Dawn
(OND) Veterans in Department of Veterans Affairs Programs,
2002-2012, 207
7-8 Number of Operation Iraqi Freedom (OIF)/Operation Enduring
Freedom (OEF)/Operation New Dawn (OND) Veterans Treated
in Department of Veterans Affairs Programs for an SUD
Diagnosis, 207
7-9 Average Number of Beneficiaries by TRICARE Region for Fiscal
Year 2010, 210
7-10 Number and Rate per 1,000 Beneficiaries Utilizing the Purchased
Care Sector for SUD Care, by TRICARE Region (FY 2010), 210
7-11 Medications for Addiction Treatment Given to Active Duty
Service Members and Active Duty Family Member Adult
Dependent Beneficiaries (aged 18 and over), All Systems of Care
(FY 2010), 212
7-12 Number of Beneficiaries Receiving SUD Care by Type of Purchased
Care Facility, North Region (FY 2010), 213
OCR for page R19
TABLES, FIGURES, AND BOXES xix
7-13 Number of Beneficiaries Receiving SUD Care by Type of Purchased
Care Facility, West Region (FY 2010), 214
7-14 Number of Beneficiaries Receiving SUD Care by Type of Purchased
Care Facility, South Region (FY 2010), 214
7-15 Number of Beneficiaries with Claims in Purchased Care Settings,
by Type of SUD Care (FY 2010), 215
8-1 Alcohol and Drug Abuse Prevention and Treatment (ADAPT)
Workforce, 229
8-2 Army Substance Abuse Program (ASAP) Prevention
Workforce, 232
8-3 Army Substance Abuse Program (ASAP) Clinical Workforce as of
December 2011, 233
8-4 Substance Abuse Rehabilitation Program (SARP) Workforce, 234
8-5 Substance Abuse Counseling Center (SACC) Workforce, 236
I-1 Ratings of Policy-Relevant Strategies and Interventions, 374
FIGURES
2-1a Active duty component members with and without children, 36
2-1b Reserve component members with and without children, 36
2-2a Active duty component family status, 37
2-2b Reserve component family status, 37
2-3 Substance use trends for active duty military personnel, past 30
days, 1980-2008, 39
2-4 Use of selected categories of illicit drugs, past 30 days, DoD
branches, 2002, 2005, and 2008, 40
2-5a Standardized comparisons of active duty component personnel
and civilians, heavy alcohol use and past 30-day smoking, by age
group, 2008, 46
2-5b Standardized comparisons of active duty component personnel and
civilians, past 30-day illicit drug use, by age group, 2008, 47
2-6 Prevalence of alcohol-related disorders among the active duty
component (rates per 100,000), 51
2-7 Prevalence of drug-related disorders among the active duty
component (rates per 100,000), 52
2-8 Prevalence of alcohol- and other drug-related disorders among the
reserve component (rates per 100,000), 53
2-9 Prevalence of alcohol- and other drug-related disorders among
dependents, 56
OCR for page R20
xx TABLES, FIGURES, AND BOXES
2-10 Incidence rates of acute and chronic alcohol-related inpatient
and outpatient cases, active duty component, U.S. military,
2001-2010, 59
2-11 Alcohol use problems and interventions, 60
3-1 Defense Enrollment Eligibility Reporting System (DEERS), 71
3-2 TRICARE organization of services, 72
3-3 The uniformed services, 72
3-4 Terminology related to the uniformed services health care
system, 73
7-1 Number of Army Substance Abuse Program (ASAP) treatment
enrollments by substance of abuse for fiscal year 2010, 195
H-1 Components of health care delivery systems, 371
BOXES
3-1 TRICARE Patient Priority System, 77
4-1 ACO Accreditation Standards, 87
4-2 Dimensions of American Society of Addiction Medicine’s (ASAM’s)
Patient Placement Criteria, 88
4-3 National Quality Forum’s Voluntary Consensus Standards for the
Treatment of Substance Use Conditions, 92
6-1 Policies and Directives Related to Substance Use Disorders, 138
6-2 Army Substance Abuse Program (ASAP) Prevention and Treatment
Capabilities, 154
6-3 Military Studies of the National Institute on Drug Abuse and
National Institute on Alcohol Abuse and Alcoholism, 176
7-1 A Soldier’s Untreated Substance Abuse, 189
7-2 DoD-Wide Programs to Increase Access to Behavioral Health Care
Services and Encourage Help Seeking, 202
7-3 Access Standards of the Veterans Health Administration for
SUD Care, 204
7-4 TRICARE Policies Governing Access to SUD Care, 209
8-1 12 Core Functions of Substance Abuse Counselors, 231
8-2 Psychological Health Risk-Adjusted Model for Staffing
(PHRAMS) Diagnosis and Risk Groups, 239
OCR for page R21
Acronyms and Abbreviations
AA Alcoholics Anonymous
ABAM American Board of Addiction Medicine
ABC Alcohol Brief Counseling
ACO Accountable Care Organization
ACSAP Army Center for Substance Abuse Programs
ADAMS Alcohol and Drug Abuse Management Seminar
ADAPT Alcohol and Drug Abuse Prevention and Treatment
ADC alcohol and drug counselor
ADCO alcohol and drug control officers
ADFM active duty family member
ADMITS Alcohol and Drug Management Information Tracking
System
ADSM active duty service member
ADT active duty training
AFI Air Force Instruction
AFIP Armed Forces Institute of Pathology
ALARACT All Army Activities
APA American Psychiatric Association
AR Army regulation
ARI alcohol-related incident
ARM Alcohol-Related Misconduct
ASAC Adolescent Substance Abuse Counseling
ASAM American Society of Addiction Medicine
ASAP Army Substance Abuse Program
xxi
OCR for page R22
xxii ACRONYMS AND ABBREVIATIONS
AUD alcohol use disorder
AUDIT Alcohol Use Disorders Identification Test
BAM Brief Addiction Monitor
BASIC Building Alcohol Skills Intervention Curriculum
BHIVES Buprenorphine and HIV Care Evaluation and Support
BHOP Behavioral Health Optimization Program
BUMED Bureau of Medicine and Surgery
CARF Commission on Accreditation of Rehabilitation
Facilities
CATEP Confidential Alcohol Treatment and Education Pilot
CBT cognitive-behavioral therapy
CDC Centers for Disease Control and Prevention
CD-MART Controlled Drug Management Analysis and Reporting
Tool
CEOA comprehensive effects of alcohol
CFR Code of Federal Regulations
CHCBP Continued Health Care Benefit Program
CM contingency management
CO commanding officer
COBRA Consolidated Omnibus Budget Reconciliation Act
CoRC Culture of Responsible Choices
CPG Clinical Practice Guideline
CSAP Center for Substance Abuse Prevention
CSAT Center for Substance Abuse Treatment
CSF Comprehensive Solider Fitness
DAPA Drug and Alcohol Program Advisor
DCoE Defense Centers of Excellence
DDCAT Dual Diagnosis Capability in Addiction Treatment
DEA Drug Enforcement Agency
DEERS Defense Enrollment Eligibility Reporting System
DEFY Drug Education for Youth
DoD Department of Defense
DODD Department of Defense Direction
DODI Department of Defense Instruction
DOJ Department of Justice
DOT Department of Transportation
DRI drug-related incident
DSM Diagnostic and Statistical Manual
DUI driving under the influence
DWI driving while intoxicated
OCR for page R23
ACRONYMS AND ABBREVIATIONS xxiii
EAP Employee Assistance Program
EBP evidence-based practices
ECF executive cognitive function
EUDL Enforcing Underage Drinking Laws
FEHBP Federal Employees Health Benefits Program
FOCUS Families OverComing Under Stress
FTE full-time equivalent
FY fiscal year
GAO Government Accountability Office
GAT Global Assessment Tool
GBL gamma butyrolactone
GHB gamma-hydroxybutyric acid
HRB Health Research Board
HRSA Health Resources and Services Administration
IC&RC International Certification and Reciprocity
Consortium
ICD International Classification of Diseases
IDS integrated delivery system
IDT Inactive Duty Training
IHI Institute of HealthCare Improvement
IMCOM Installation Management Command
IntNSA The International Nurses Society on Addictions
IOM Institute of Medicine
IOP intensive outpatient
JCAHO Joint Commission on Accreditation of Healthcare
Organizations
LCSW Licensed Clinical Social Worker
LIP Licensed Independent Practitioner
LMFT Licensed Marriage and Family Counselor
LOD line of duty
LPC Licensed Professional Counselor
LSD lysergic acid diethylamide
MAAC Marine Alcohol Awareness Course
MCO Marine Corps Order
MDMA 3,4-methylenedioxy-N-methylamphetamine
MDR M2 Data Repository
OCR for page R24
xxiv ACRONYMS AND ABBREVIATIONS
MEDCOM Medical Command
MET motivational enhancement therapy
MHAT Mental Health Advisory Team
MHS Military Health System
MORE My Ongoing Recovery Experience
MOU Memorandum of Understanding
MTF military treatment facility
NCQA National Committee for Quality Assurance
NDAAC Navy Drug and Alcohol Advisory Council
NDACS Navy Drug and Alcohol Counselor School
NIAAA National Institute on Alcohol Abuse and Alcoholism
NIDA National Institute on Drug Abuse
NOAA National Oceanic and Atmospheric Administration
NORTH STAR New Orientation to Reduce Threats to Health from
Secretive Problems That Affect Readiness
NQF National Quality Forum
NRC National Research Council
NREPP National Registry of Evidence-Based Programs and
Practices
OEF Operation Enduring Freedom
OIF Operation Iraqi Freedom
OND Operation New Dawn
ONDCP Office of National Drug Control Policy
PC prevention coordinator
PCM primary care manager
PCP phencyclidine
PDHA Post-Deployment Health Assessment
PDHRA Post-Deployment Health Reassessment
PDMP Prescription Drug Monitoring Program
PEC Pharmacoeconomic Center
PFL Prime for Life
PHA Periodic Health Assessment
PHRAMS Psychological Health Risk-Adjusted Model for
Staffing
PMART Prescription Medication Analysis Reporting Tool
POC Pharmacy Operations Center
POS point of service
PREVENT Personal Responsibility and Values Education and
Training
PTSD posttraumatic stress disorder
OCR for page R25
ACRONYMS AND ABBREVIATIONS xxv
RE Resiliency Element
ROSC recovery-oriented systems of care
RT resiliency training
RTCQ Readiness to Change Questionnaire
SACC Substance Abuse Counseling Center
SACO Substance Abuse Control Officer
SAIC Science Applications International Corporation
SAMHSA Substance Abuse and Mental Health Services
Administration
SAODAP Special Action Office for Drug Abuse Prevention
SAPST Substance Abuse Prevention Specialist Training
SARP Substance Abuse Rehabilitation Program
SBIRT screening, brief intervention, and referral to treatment
SECNAVINST Secretary of the Navy Instruction
SIP Short Index of Problems
SM service member
STD sexually transmitted disease
SUAT Substance Use Assessment Tool
SUD substance use disorder
SUDRF Substance Use Disorder Rehabilitation Facility
TAMP Transitional Assistance Management Program
TAP Technical Assistance Publication
TBI traumatic brain injury
TDP TRICARE Dental Plan
TMA TRICARE Management Activity
TPR TRICARE Prime Remote
TRS TRICARE Reserve Select
TSF twelve-step facilitation
UPL Unit Prevention Leader
URI unit risk inventory
USAF U.S. Air Force
USMC U.S. Marine Corps
VA Department of Veterans Affairs
VET veterans
VHA Veterans Health Administration
WHO World Health Organization
WTB Warrior Transition Brigade
WTU Warrior Transition Units
OCR for page R26
